How CareDox helps insurers improve children's health—one school nurse at a time

Failed repeal could still hurt enrollment: Fitch

The House Republicans' failed attempt to repeal and replace the Affordable Care Act will likely result in lower enrollment on marketplaces created by the health law and more uncompensated care for hospitals in 2018, according to a new analysis published Monday by Fitch Ratings.

The credit-rating company said the impact of the failed replacement effort won't be evident until next year. That's because the open enrollment period for people purchasing Qualified Health Plans has already ended, with about 12 million people buying coverage.

Perhaps more illuminating is Fitch's take on the likelihood of the Trump administration's pursuit of policies that would stabilize individual insurance markets.

"During the presidential campaign, there was discussion of various policy objectives that could be pursued to stabilize the exchanges, but there is currently little political will to move forward with such an agenda," Fitch said.

Locally 3.6 million people either bought or enrolled in coverage from the New York State of Health marketplace, including private insurance plans and Medicaid, as of Jan. 31.

The report described how some markets have already become dysfunctional, with insurers pulling out and premiums rising. New York still had 14 companies selling coverage this year. Fitch cites Kaiser Family Foundation data showing premiums for the second-lowest-cost silver plan, a key benchmark for subsidies, rising more than 20% this year. But what Fitch ignores is Kaiser's analysis of tax credits that show a nonsmoking 40-year-old New Yorker who earns $30,000 a year would have paid $1 less this year for the second-lowest-cost silver plan compared to last year. —J.L.

WellCare adds NYP flagship hospitals to network

WellCare of New York has recently added New York-Presbyterian's flagship hospitals—Weill Cornell Medical Center and Columbia University Medical Center—to its network as it looks to attract more Medicaid customers in northern Manhattan.

"Our Medicaid population has access to that robust network. It's a real win," said John Burke, president of WellCare of New York, the local branch of the Tampa-based, publicly-traded insurer WellCare Health Plans, which has 238,000 members in New York, mostly in its Medicaid managed-care, Medicare Advantage and Medicare prescription drug plans.

The insurer already had contracts with NYP's regional hospitals, such as Lower Manhattan Hospital and NYP/Brooklyn Methodist.

Separately, WellCare opened a new "welcome room" in Chinatown, at 35 E. Broadway, on Monday. The company has 11 of these centers in New York, including six in the city. It uses them to educate potential customers about its Medicaid and Medicare Advantage plans.

For instance, Burke said, a WellCare associate might inform a customer that he qualifies for the Essential Plan and is eligible to receive premium-free coverage. The company has 50 associates focused on sales to Asian New Yorkers, and staff members at the Chinatown location speak Mandarin, Cantonese and Fukienese.

WellCare also provides services at storefronts, such as health screenings and classes in smoking cessation, nutrition and exercise. Brick-and-mortar storefronts have become a popular sales and marketing tool for New York insurers, including EmblemHealth, which has four neighborhood care centers, and Healthfirst with its 15 help centers, including six in Queens alone. —J.L.

Crain's completes lineup for behavioral health summit

The state's massive restructuring of its health system aims to better integrate care for behavioral and physical health conditions.

AtCrain's May 9 summit, The Future of Behavioral Health, attendees will hear from providers, insurers, leaders of a digital health startup and the Staten Island district attorney, Michael McMahon. They'll share their views on the importance of treating mental illness and substance-use disorders and discuss the challenges of doing so under DSRIP, the state's $7.4 billion Medicaid reform program.

Our keynote speaker, Patrick Corrigan, a doctor of psychology and a distinguished professor at the Illinois Institute of Technology, is a well-known researcher on the role that stigma plays in mental health care. He is editor-in-chief of the American Journal of Psychiatric Rehabilitation.

The first panel, Integrating Primary Care and Behavioral Health, features speakers from The Institute for Family Health, Mount Sinai Health System, Healthfirst and Quartet, a Manhattan-based startup.

For the second panel, From Criminals to Patients: Caring for Drug Users, Crain's has confirmed Luke Bergmann, senior director of behavioral health at NYC Health + Hospitals, as a panelist. He joins McMahon as well as representatives from New York Harm Reduction Educators, the Richmond County District Attorney's Office and Brightpoint Health.

AT A GLANCE

DSH'S FUTURE: Following Friday's demise of the American Health Care Act, the Greater New York Hospital Association is looking ahead to the next big legislative battle for area hospitals: eliminating pending cuts to Medicaid disproportionate share payments, Kenneth Raske, president of the trade association, told members in a letter Monday. New York is expected to face $300 million in DSH cuts on Oct. 1.

TRANSGENDER SURGERY: NYC Health + Hospitals/Metropolitan became the first public hospital in the city to perform gender-affirming surgery on a transgender individual, the hospital said. "We want our patients to know we will fight to protect their health care needs, even as they are being threatened at a federal level," said Alina Moran, Metropolitan's chief executive, in a statement.

How CareDox helps insurers improve children's health—one school nurse at a time

As insurers seek out ways to engage patients and lower health costs, they often have trouble ensuring that children get the care they need.

CareDox, a Manhattan startup that recently raised $6.4 million, aims to help solve the problem of missed checkups and vaccinations by connecting health plans with one of the most vital health care provider's in children's lives: the school nurse.

"There was an unbelievable realization that schools are the most important and underserved health network in the country," said Hesky Kutscher, CareDox founder and chief executive.

The company, founded in 2014, offers a care-coordination platform that allows the school nurse to share information with parents and keep track of students' medical records.

It currently covers 1.5 million students in more than 2,000 schools, including major deals with the Chicago Public Schools and Florida's Broward County Public Schools. The company is focusing on midsize districts before going after the Big Kahuna in its own backyard: New York City's Department of Education, the country's largest school district, with 1.1 million students.

Here's how the business model works: Insurance companies pay CareDox a monthly fee for each child it covers to implement the system in a local school district. Then the health plans pay for the implementation of the software and the training of school nurses.

Many of the nurses are willing to put up with the hassle of learning a new system because it enables them to better manage the myriad medication lists and care needs of students, said Geoffrey Smith, founder and managing partner at Digitalis Ventures, which led CareDox's recent funding round.

CareDox allows insurers to promote wellness visits and vaccinations and arrange to deliver some services, like flu shots, in schools.

The company's $6.4 million Series A funding round included additional funding from First Round Capital, Giza Venture Capital, TEXO Ventures and Prolog Ventures.

Smith said he invested in CareDox because of its potential to take advantage of a shift toward value-based medicine, in which providers and insurers are trying to manage patients' care "as technology pushes health care out of the doctor's office and into our lives."

Smith added, "If value-based care is the norm, there is more risk for providers."

A major challenge for CareDox will be maintaining security of patient records—and school districts' confidence in that security. The company must comply with the Health Insurance Portability and Accountability Act and the Family Educational Rights and Privacy Act.

But there are signs that CareDox is succeeding in convincing superintendents that its product will improve students' health. The number of students enrolled in the platform, which requires parental consent, increased by 45% in the past 12 months.—J.L.

Crain’s New York Business is the trusted voice of the New York business community—connecting businesses across the five boroughs by providing analysis and opinion on how to navigate New York’s complex business and political landscape.